EP1212022B1 - Device for treating opaqueness and/or hardening of an unopened eye - Google Patents

Abstract

Procedure involves exposing the closed eye (1) and any opaqueness or cataract (5) within it to an ultra-short laser (10) pulse without any need for opening the eye. Pulse duration is 5 seconds maximum and optimally less than 0.1 seconds, with wavelength frequency in the kHz range. An independent claim is made for a device for removal of eye cataracts etc. using a pulsed laser.

Description

The invention relates to a device for Treatment of cloudiness and / or hardening of an unopened Eye. In particular, the invention relates to a laser system to purify the particular aging human eye of gray-shrouded in the cornea, the lens or the vitreous to restore transparency in the eye.

In ophthalmology, it is known that in particular in the aging eye cloudiness in the lens (cataract) or in the vitreous or cornea. Treatment in the advanced stage is currently limited to that the lens in the context of a cataract surgery against a Plastic lens replaces the vitreous by vitrectomy exchanged for silicone oil or transplanted the cornea. It is known, the operation of the cataract, as well to perform a vitrectomy of a vitreous by means of a laser. In both cases, the laser beam is in the context of an operation brought directly to the treating tissue. When Laser has especially the Er: YAG laser with the emission wavelength proven by 2.94 microns, whose radiation is very strong is absorbed by water. For the transport of the laser radiation Needles with fiber optics are up to the place of treatment guided. Even if by now needles with diameters of about 1mm are feasible, the need remains Surgery. A device for implementation a laser phacoemulsification is for example in DE 19718139 described.

WO-A-9 425 107 describes a device according to the preamble of claim 1.

Also known are surgical techniques in which the eye does not open is, but the laser light through the normal path of the Sehvorganges is performed in the eye. This includes the possibility by focusing on fs laser pulses (300 fs, 1 μJ, 780 nm) in the interior of the cornea to an optiche disruption achieve, which leads to bubble formation. By unfolding a lamella can prepare an intrastromal lenticle whose removal causes a refractive correction. It is also known that with the help of ns pulses of a Q-switched Nd: YAG laser disruptively disrupt the gray after-skin can be removed.

A targeted treatment of cloudy areas already in the initial stage so far, apart from medical methods, not possible. So the known laser methods are not suitable, without opening of the eye, the clouded areas in the eye to eliminate. It is therefore an object of the invention to provide a device which makes it possible to Cloudy areas in the eye dissolve.

Another age-related phenomenon is presbyopia. One reason for this is the hardening of the lens, the e.g. can occur by incorporation of substances. In addition to the use of glasses, has recently been often the Photorefractive keratectomy (PRK), to correct the ametropia used. Elimination of hardening itself is not possible yet. It is therefore another task the invention to provide a device with which the Ability to contraction of the lens is increased again.

The object of the present invention is therefore to to provide a device with which turbidity and / or hardening of an eye can be resolved.

This task is performed by the device solved according to the independent claim. Advantageous embodiments The invention are specified in the subclaims.

In particular, the object is achieved by a method for resolution from cloudiness and / or hardening of an unopened Auges solved (which is not the subject of the present invention is), wherein the turbidity and / or the hardening resolved by means of at least one ultrashort pulse of a laser without opening the eye. By the Use of an ultra-short pulse passing through the transparent Eye structure is sent, it comes on the retina or other uninvolved regions to no thermal or athermal Damage. In the working plane (e.g., the lens, the Vitreous humor or in the cornea) such an energy density prevails, that in the fully transparent medium of the eye nothing happens, but on heterogeneous punctual clouding Disruptions induced by local absorption are induced lead to the dissolution of these impurities. These disruptions lead to the evaporation of these impurities. The any resulting gas bubbles (caviole) filled up in a few hours and have disappeared. The dissolved impurities are absorbed and / or blurring reduces or disappears altogether.

As ultrashort pulses pulses are preferably used, the are in the ps range, particularly preferably pulses that are in the fs range lie. Preference is given to pulses of 10 ps to 10 fs, particularly preferably used of 300 fs.

The particular advantage of the method consists in that the opacities and / or hardenings on the eye can be removed or reduced without it being necessary would be to open the eye. In this way, those with an operation associated risks avoided. Furthermore can with the procedure by appropriate Choice of the energy of the ultrashort pulse a gentler and be made in small stages treatment.

Preferably, the ultrashort pulses are amplified, in particular preferred with the Chirped Pulse Amplification method (CPA method).

In a preferred method, the Turbidity and / or hardening by means of at least one Pulse train of a duration of less than 5s, preferably less than 3s, more preferably less than 0.1s of ultrashort pulses dissolved. Very particularly preferred are Pulse lengths in the range of 10 ps to 10 fs and in particular preferably provided by about 300 fs. By choosing one Pulse train can be about determining the duration of energy input be pre-determined in the area to be treated. By choosing extremely short pulse trains, it is beyond possible to avoid efficiency losses, for example through movement of the eye during treatment could. Particularly preferably, the pulses have a Duration of less than 10 ps. It is also conceivable to use the pulse train in continuous operation until the desired effect was achieved. Very particularly preferred You can also use single pulses and very short pulse trains to be through an iterative follow-up of the treatment success to achieve a particularly gentle treatment.

In another preferred method pulse trains are transmitted at a repetition rate, in particular with a repetition frequency in the kHz range. Here are the pulse trains themselves again with a Repetition frequency superimposed. That way, despite the choice a longer pulse train or even a continuous operation of the Energy input into the area to be treated again in time be varied. This is a more gentle treatment avoiding any thermal or athermal Damage to the eye in areas that are not treated should, possible.

In another preferred method becomes a laser radiation of a wavelength distribution chosen for the opacities and / or hardenings a higher Absorption and / or lower reflection, as for the remaining components of the eye. That's it possible to adjust the energy density such that only on Place local absorption the necessary density to ignite a optical breakthrough is achieved. This selective attitude is due to the increased absorption of cloudiness and / or hardening at the selected wavelengths. Particularly preferably, a laser is selected for whose wavelength the eye has a high transmissivity has. The wavelength is preferably 350 to 1300 nm. Most preferably, a laser is selected for its Radiation the sensitive areas like the retina or the macula has a slightly lower sensitivity. This may be preferred by a lower Absoptionsvermögen these areas are in the eye for the chosen radiation. Furthermore, this may be preferred by a higher reflectivity of the non-treated areas of the eye happen. The radiation can be so independent from that by focusing producible energy density due to the absorption and Reflection behavior already no harm in the non-treated To arrange areas of the eye.

In another preferred method ultrashort pulses are aligned so that within the cloudiness and / or hardening energy densities occur which dissolve the cloudiness and / or hardening and at the same time in the sensitive area of the eye no destruction the tissue enters. This may be in addition to the choice of wavelength by focusing the beam and a corresponding one Beam guidance of the pulses done. So can by a Shaping the beam geometry of the pulse in the area to be treated Tissue energy densities are coupled, which too a disruption (and thus dissolution) of the pathological (less transparent) tissue lead. At the same time the Be shaped so that in the area of sensitive areas, like the retina and especially the macula, energy densities occur that do not lead to the destruction of this tissue.

This can preferably be achieved by the beam guidance, after passing the beam through the one to be treated Target range of the beam is widened so that the energy densities in the sensitive area are so small that it is not damage to the area may occur. At another preferred method is the complete or one predetermined large area of the eye lens with a convergent beam and an energy density in the lens area below that of the irradiated optical breakthrough. The focus is on this Vitreous. On the other hand, the energy is chosen so that at Transparency of the lens in focus in the vitreous an optical Breakthrough arises. Because the optical breakthrough in focus All energy is consumed with respect to the macula a high treatment safety can be produced. any Blistering in the vitreous relax at short notice.

In another preferred method the alignment of the ultrashort pulses takes place a deflection device and / or a focusing optics and / or a contact glass. This allows the ultrashort pulses and the beam described thereby not only exactly to that it can also be targeted also the desired energy density in the target area be selected. By resorting to known devices can the process of the invention implemented inexpensively become.

In another preferred method be before the actual treatment by a Measurement of reflected radiation of low energy information gained over the opacities and / or hardenings and this information will flow into the choice of Align the energy of the pulses to be used. To the It is in particular the protection of the sensitive areas also in the context of the invention, before the actual treatment radiation with much less harmless to the eye To irradiate insentities and from radiation, which is reflected, for example, on the opacities, conclusions to align the laser, as well as to the required Derive radiation dose in the respective radiation direction. As the energy of radiation in the disruption of Clouding is largely used up, is an optimal adjustment the beam geometry on the turbidity to be treated also beneficial in the gentle treatment of the sensitive Areas. By the information thus obtained can be treat the identified areas individually and purposefully. In particular, this information is also between the individual treatment steps possible to determine To what extent the treatment has already shown success. So is For example, it is possible for an ultrashort pulse or a Impulszug a signal with lower Engerie nachherzuschikken, to get information about it through the ultrashort Pulse or pulse train caused change in the treatment area to win.

In another method of treatment The presbyopia of an eye will be in the lens of the eye Bubbles are created and these bubbles are filled up with liquid, without the eye having to be opened. Through this Blistering within the lens becomes the lens material loosened. The bubbles thus formed become automatic refilled with liquid. Through this with liquid filled bubbles, a lens is created, the one has higher flexibility than the original lens. But this increases the accommodation of the lens. So are in particular inclusions or indurations, too lead to a reduction of the contractility of the lens, treatable by the method according to the invention.

Particularly preferred are the bubbles in the edge region of the Lens generated as bubble fields. This setting of bubbles in the edge region or in the edge zone of the lens leads to Filling with liquid to soften the lens. This leads to a higher flexibility and thus to a higher accommodation of the lens. By a symmetrical Arrangement of the bubble fields, the Accommodation possibility of the lens obtained symmetrically stay. If there is only partial hardening of the lens, so By targeted bubble formation the flexibility of the lens be increased in a special area. This allows the Overall symmetry of the lens in the Akkonunodation improved become.

The object of the present invention is further solved by a device for the treatment of turbidity and / or Hardening of an unopened eye comprising a laser with a frequency distribution in the range of 350 nm to 1300 nm and a device for generating ultrashort pulses, wherein means for aligning the ultrashort pulses is provided, comprising a deflecting device and / or a Focusing optics and / or a contact glass, wherein a Control device is provided, which is the device for Alignment of ultrashort pulses depending on Information about the cloudiness and / or hardening controls. By this device, the above Advantages of the method according to the invention are implemented. The optical means for coupling the radiation exist preferably from a tunable focusing optics, Deflection mirrors of a micromanipulator, contact lenses, special mirror contact lenses and surgical microscopes or Slit lamps. By means of these elements it is possible to use the Beam within the eye in such a way and align that the Energy input in the areas to be treated very accurately are predeterminable, without the outside of this to be treated Areas harmful for the existing tissue there Energy density could occur. In another preferred Embodiment of the present invention is a Control device provided with the means for Alignment of the ultrashort pulses is controllable, in particular preferably depending on information about the turbidity and / or hardenings. By this control device can the intormat, ions, over the areas to be treated were determined, be prepared so that the pulse duration, Sequence and energy density to be introduced can be determined and the control device based on the determined parameters the Device for aligning the ultrashort pulses thereby can align that the individual elements of the optical Systems are set by the control device so that the desired area with the predetermined energy input can be treated. The laser is chosen to be pulses in the ps range, preferably in the fs range can radiate.

The laser as a coherent light source comprises in one further, a facility for generating at least one Pulse train. This pulse train preferably has a duration of less than 5s, more preferably less than 2s and especially preferably less than 0.1 s. Especially Pulse lengths in the range of 10 ps to 10 fs are preferred provided and most preferably pulse lengths of about 300 fs. The device according to the invention may also be preferred provide pulse trains in continuous operation or single pulses send out. With the device for generating pulse trains with a repetition frequency, particularly preferably in the kHz range, of the laser as a coherent light source it is possible the superposition described in the method according to the invention to generate the individual pulse trains by the repetition frequency, what the gentle introduction of the energy in that too treated area increases.

Particularly preferably, the coherent light source has a Device for generating a laser radiation with a Frequency distribution on, for the turbidity and / or Hardening a higher absorption and / or a lower one Reflection than for the other components of the Eye. Especially preferred is a tunable Laser use, which radiate in the range 350 nm to 1300 nm can. Particularly preferred is a laser is provided which in the Can radiate range of 780 nm, such as a Ti-sapphire laser or further preferably in the range 1060 nm, such as for example, a Nd: glass laser. By such a laser the advantages of the method according to the invention can be achieved become.

Fig. 1 Ein Ausführungsbeispfel der erfindungsgemäßen Vorrichtung zur Behandlung einer Trübung im Gesichtsfeld des Glaskörpers;

Fig. 2 Ein Ausführungsbeispiel der vorliegenden Erfindung zur Behandlung der Presbyopie;

Fig. 3 Ein weiteres Ausführungsbeispiel der vorliegenden Erfindung zur Behandlung der Augenlinse;

Fig. 4 Ein weiteres Ausführungsbeispiel der vorliegenden Erfindung zur Behandlung eines speziellen Bereichs der Augenlinse und

Fig. 5 ein Diagramm eines Impulszuges mit Darstellung der Zeitachse und der Amplitude.

Embodiments of the invention and advantageous embodiments will be explained in more detail below with reference to drawings. Showing:

1 shows an embodiment of the device according to the invention for the treatment of a haze in the visual field of the vitreous body;

Fig. 2 shows an embodiment of the present invention for the treatment of presbyopia;

Fig. 3 shows another embodiment of the present invention for treating the crystalline lens;

Fig. 4 Another embodiment of the present invention for treating a specific area of the eye lens and

Fig. 5 is a diagram of a pulse train showing the time axis and the amplitude.

FIG. 1 shows a first embodiment of the present invention Invention for the treatment of haze in the vitreous body Field of vision directly behind the lens. A laser 10, here a mode-locked laser, is a focusing optics 12 downstream. Behind the focusing optics is a deflection mirror arranged with micromanipulator 14. On the to be treated Eye 1, a contact glass 15 is applied. Behind the eye lens there is a cloudy area 5. For observation serves a surgical microscope with slit lamp 19th

With the mode-synchronized laser system are ultrashort Laser pulses preferably 10 ps to 10 fs generated, which with the chirped pulse amplification method will be amplified to have pulse energies above 1 mJ available in the kHz range. At the wavelength of 780 nm (Ti-sapphire) or 1060 nm (Nd: glass) have the transparent areas of the treated Cornea, lens or vitreous a slight absorption, when irradiated with sufficiently low energy densities of the ultrashort pulse will not be harmed. Behind the Laser 10, a focusing device 12 is arranged, through the beam is aligned and focused. The beam is about the deflection mirror with micromanipulator 14 through the Contact glass 15 focused on the clouded area 5.

In operation, the laser emits pulse trains 25 of ultrashort pulses 20 off. These are only from the morbid clouded areas which allows selective treatment becomes. The ultrashort pulses lead to a locally limited, disruptive comminution process of tarnished tissue without harmful thermal side effects. The local, selective and athermal comminution process leads to Replenish the induced vesicles to restore the Transparency in this area. The possibly arising in the glass body Cavitations will be back within a short time filled up with fluid from the body. This will be the area 5 again transparent after treatment.

With appropriate energy preselection, cloudy areas can also be used be treated in the eye lens with this arrangement. The Energy is chosen so that the transparent components the eye lens no absorption of the selected wavelength allow. The clouded areas in the eye lens, however absorb the radiation and thus carry the ultrashort pulses to a localized, disruptive comminution process the clouded tissue also in the eye lens without harmful thermal side effects. The energy passing through the clouded Areas not absorbed are in focus in the vitreous body used up by disportion and so can the retina do not harm. Focusing in the vitreous Cavitations become timely with fluid of the body again filled up and are therefore transparent again.

In Figure 2 is an embodiment of the present invention presented for the treatment of presbyopia. The device essentially corresponds to that in Figure 1. However The beam deflection of the pulse train is performed by the deflection mirror with micromanipulator 14 such that the focus in Edge of the lens comes to rest. That way you can the bubbles, preferably in the edge region of the Lens, which are preferred after filling by body fluid higher flexibility and thus Accommodate. That way you can Whole bubble fields are set, leading to a regional Softening of the lens and thus to a corresponding increase to lead the flexibility.

FIG. 3 shows a further embodiment of the present invention Invention for the treatment of the eye lens shown. This embodiment corresponds essentially Structure of the embodiment shown in Figure 1. However, by the optical system 12 used herein the beam is widened so that it is in the area of the eye lens 2 is adjustable so that there is an energy input, the destruction of the clouded areas 5 in the Lens 2 leads, while in the further course of the beam so widened is that the energy in the area of the macula 7 so low is that no damage is done to the tissue here can be.

In the treatment is by special divergent beam guidance as well as suitable irradiation as well as possible automated Scanning the radiation conducted so that neither the Retina damaged other than the diseased areas can be.

FIG. 4 shows a further embodiment of the present invention Invention for treating a specific area of Eye lens 2 shown. Here, 15 is in the contact glass a mirror 16 is provided, with the help of the pulse train on a special area of the eye lens are aligned can. The beam hits the deflection mirror with micromanipulator 14, the beam through the contact glass 15 on the Mirror 16 in the contact glass 15 through which the beam is aligned in the area of the eye lens 2, in which the cloudy area 5 present.

FIG. 5 shows a diagram of a pulse train 25 with representation of the time axis and amplitude. The individual ultrashort pulses 20 have a width of a few femto seconds. The pulse train 25 is formed by three pulse packets 22 of different lengths 22.1, 22.2 and 22.3 and superimposed by a frequency sequence with the period T. In this way, the energy input can be varied again by the ultrashort pulses. While the time t is shown on the x-axis, the amplitude A is indicated on the y-axis. Instead of a frequency sequence in the kHz range can also be thought of a linear or quasi-linear increase envelope or descending envelope. The first pulse packet 22.1 consists of a single pulse 20. The pulse train 22.2 consists of a plurality of individual pulses, which are themselves spaced apart by the time T. T is usually in the ms range, while the width of the individual pulses 20 is in the fs range.
Together with the pulse packet 22.3, the pulse packets form the pulse train 25.

According to the invention a device for Treatment of cloudiness and / or hardening of an unopened Presented to the eye. A particular advantage of the invention Solution is that treatments inside of the eye are possible without a surgical instrument must be introduced into the eye.

LIST OF REFERENCES,

1.

eye

Second

lens

Third

vitreous

4th

cornea

5th

opacities

7th

macula

10th

laser

12th

optical system (focusing optics)

14th

Deflection mirror with micromanipulator

15th

Contact glass

16th

Mirror in the contact glass

19th

Surgical microscope with slit lamp

20th

Ultra short pulse

22nd

burst

25th

pulse

Claims (5)

1. Device for treating opacities (5) and/or hardenings of an unopened eye (1) including a laser (10) with a frequency distribution in the range of 350 nm to 1300 nm as well as an apparatus for generating ultra-short pulses (20), an apparatus being provided for directing the ultra-short pulses, comprising a deflection apparatus (14) and/or a focussing optic (12) and/or a contact lens (15),
   characterized in that
   a control apparatus is provided which controls the apparatus for directing the ultra-short pulses according to the data relating to the opacity (5) and/or hardenings.
2. Device according to claim 1,
   characterized in that
   the laser (10) has an apparatus for generating at least one pulse train (25) of a duration of less than 5 seconds, preferably less than 2 seconds, particularly preferably less than 0.1 seconds of the ultra-short pulses (20).
3. Device according to one of claims 1 or 2,
   characterized in that
   this includes an apparatus for generating pulse trains (25) with a repetition frequency, in particular with a repetition frequency in the kHz range.
4. Device according to one of claims 1 to 3,
   characterized in that
   the laser (10) has an apparatus for generating a laser radiation with a frequency distribution which has a higher absorption and/or a lower reflection for the opacities (5) and/or hardenings than for the other components of the eye (1).
5. Device according to one of claims 1 to 4,
   characterized in that
   the laser (10) has an apparatus for generating a laser radiation with a frequency distribution in the range of 780 nm to 1060 nm.

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